Healthcare Provider Details

I. General information

NPI: 1487689238
Provider Name (Legal Business Name): MINIMALLY INVASIVE SURGICAL TEAM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SOUTH CHEVY CHASE DRIVE 101
GLENDALE CA
91205
US

IV. Provider business mailing address

801 SOUTH CHEVY CHASE DRIVE 101
GLENDALE CA
91205
US

V. Phone/Fax

Practice location:
  • Phone: 818-265-2260
  • Fax: 818-265-2268
Mailing address:
  • Phone: 818-265-2260
  • Fax: 818-265-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA81027
License Number StateCA

VIII. Authorized Official

Name: DR. GEORGE KEVORK TASHJIAN
Title or Position: OWNER
Credential: M.D.
Phone: 818-265-2260